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General NPI Number Information
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NPI Number | 1700948239
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Entity Type | Organization
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Legal Business Name | CHUA FAMILY PRACTICE, PLLC
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1092 HARRISON AVE
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City | ELKINS
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State | WV
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Zip | 26241-3671
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Country | US
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Telephone | 304-637-0433
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Fax | 304-637-0435
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Provider Business Mailing Address
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Address Line | PO BOX 490
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City | ELKINS
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State | WV
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Zip | 26241-0490
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Country | US
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Telephone | 304-637-0433
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Fax | 304-637-0435
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. CONNIE M BROWN
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Credential | RN
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Telephone | 304-637-0433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | WV1833
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | WV1965
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License Number State | WV
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